Gallbladder dysfunction is a fairly common clinical condition. According to the U.S. Department of Health and Human Services, cholecystectomy (or gallbadder removal) was the seventh most common ambulatory (or out-patient) surgery in the U.S. in 2003. This is rather unfortunate considering how important the gallbladder is in overall body function; in addition to the fact that there are many successful, non-invasive natural methods in order to help it function properly.

The gallbladder is located on the right side of your body, behind the lower edge of the ribcage underneath the liver; in line with the center of the clavicle (or collarbone). Its purpose is to store bile that is manufactured by the liver, and then release the bile into the small intestine. From a digestive standpoint, bile’s purpose is to emulsify (or break down) fats in the small intestine, which allows them to be absorbed efficiently. Additionally, this allows for the proper absorption of the fat-soluble vitamins A, D, E, and K. Another role bile plays is to carry cholesterol and toxins into the intestines in order to rid them from the body. The toxins include anything ranging from pesticides, estrogens, toxic metals, and any other fat-soluble toxins. As you can see, a sluggish gallbladder (or worse, cholecystectomy) can cause a wide variety of complications.

The most common symptoms of gallbladder dysfunction include nausea, constipation, indigestion (especially after eating fatty meals), bloating (especially about half-an-hour to an hour after eating), gas, pain in the area where the gallbladder is located, pain in the right shoulder, a bitter taste in the mouth, clay or light-colored stools, and stools that float (except if you’ve consumed large amounts of fiber).

The gallbladder constricts and releases its bile via the action of a hormone called cholecystokinin (CCK). Cholecystokinin secretion is stimulated by the presence of fat- and protein-rich food that enters into the small intestine. As a result, avoiding fat completely may not be the best way to avoid gallbladder complications; because the mere presence of fat is helpful in releasing the bile that resides in the gallbladder in the first place.

The most common problem you’ve probably heard of related to the gallbladder is gallstone formation. And the most common type of stone is known as a cholesterol stone. It is not fully understood why cholesterol gallstones form, but it is generally accepted that they stem from any of the following: too much cholesterol, too much bilirubin (a breakdown product of old red blood cells), insufficient bile salts, a lack of emptying of the gallbladder, or the gallbladder not emptying enough. Cholesterol and bilirubin are normal components of bile. It is when they increase in concentration that they may become a problem. The other less common stone is known as a pigment stone.

I spoke about what causes the gallbladder to constrict (i.e.:CCK). In addition to a possible inhibition of the constriction of the gallbladder, the bile can also become thick and lose its ability to flow freely; regardless of the amount of CCK release. When this occurs, it is called cholestasis, or a suppression of the flow of bile. There are several possibilities as to why this may occur. First, realize that the largest component of bile is water. Therefore, being sufficiently hydrated is of prime importance to keep the viscosity down. Next, you must have an adequate supply of essential fatty acids, particularly omega 3’s. These fatty acids help to thin the bile to keep it flowing freely. Additionally, certain nutrients can be helpful in aiding fat metabolism and bile flow. In particular, inositol, choline, taurine, and betaine (not betaine-HCl, though it is possible that betaine-HCl may be helpful through improving overall digestion and stimulating the release of CCK). The gallbladder (and liver) can also be helped by botanicals such as milk thistle, dandelion root, and ginger. By the way, beet leaves are high in betaine, and juicing them would be best.

Other factors that can affect bile flow need to be considered as well. In particular, estrogen dominance can be a problem. Estrogen dominance refers to either: 1) too much estrogen in relation to progesterone, 2) too little progesterone, or 3) too much estrogen with normal progesterone levels. The reasons for estrogen dominance are beyond the scope of this article. Essentially, excessive estrogen can result in lithogenic (or calculi/stone forming) bile according to this article from the Annals of Surgery. Additionally, eMedicine cites a study which “postulated that estrogens cause increased cholesterol secretion and progesterone promotes biliary stasis”, thus possibly leading to gallstones or bile stasis. Low thyroid function (which can result from estrogen dominance, but certainly not always) can also cause the gallbladder to become sluggish and congested.

Women tend to be more likely to suffer from gallstones and gallbladder complications, which may further point to excess estrogen levels as being a major problem. There is a profile of a person likely to get gallbladder problems coined the “4F’s”: 1) female; 2) (let’s just say overweight); 3) forties (age); and 4) fertile (implying high levels of hormones).

Otherwise, I’ve quoted the following characteristics that put people at risk for gallbladder complications from the National Digestive Diseases Information Clearinghouse:

• women—especially women who are pregnant, use hormone replacement therapy, or take birth control pills
• people over age 60
• Native Americans
• Mexican Americans
• overweight or obese men and women
• people who fast or lose a lot of weight quickly
• people with a family history of gallstones
• people with diabetes
• people who take cholesterol-lowering drugs

However, don’t rule out a gallbladder problem if you don’t fit into any of the categories above. I commonly see gallbladder problems in all types of individuals. The most common related complaints I see are sharp, piercing pain at the right fourth rib (where it connects to the fourth thoracic vertebrae) sometimes extending upward into the neck and resulting in neck pain as well; knee pain; and digestive disturbances. If you suspect a gallbladder problem, please seek a licensed, qualified healthcare practitioner that can help you before the worst case scenario (cholecystectomy). It can be a very simple problem to manage through diet and lifestyle changes.

One last thing! For those who have had their gallbladders removed, it may be a good idea to take bile salts (in supplement form) with every meal, as there is a good chance that fat digestion will be impaired without them.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology